Prevention
A new report issued by the Centers for Disease Control and Prevention (CDC) found that although severe allergic reactions to the COVID-19 vaccine may occur, they are rare. The report, which was published on January 6, found that the risk of developing a serious allergic reaction after the vaccine is 0.001%, based on data available so far.
The news comes in the wake of warnings that people with a history of severe allergic reactions to vaccines or injectable drugs should talk to their doctor before receiving the COVID-19 vaccine. Both the Allergy & Asthma Network and the CDC say you should tell your doctor if you have had anaphylaxis, a serious and life-threatening allergic reaction that can cause difficulty breathing, to a previous injected medicine or vaccine.
However, people with a history of severe allergic reactions not related to vaccines or injectable drugs – such as food, pets, poison, environmental allergies or latex – are yet to be vaccinated, according to the CDC.
The guidance was followed after some people reported reactions to the vaccine in the United States. A health professional in Oregon was hospitalized after suffering anaphylaxis with the Pfizer vaccine; a Boston doctor with a history of seafood allergy also felt dizzy and had a racing heart after receiving the Modern vaccine.
It is important to at least be aware of these potential reactions, even if they are rare, says Jamie Alan, Pharm.D., Ph.D., assistant professor of pharmacology and toxicology at Michigan State University. “An amount of concern is justified, although it shouldn’t automatically influence someone [to not get vaccinated], ”Says Alan. “This is not a new concern, like an allergic reaction to any the vaccine is always a risk ”.
This raises some important questions, especially if you have a history of allergies. Here’s what you need to know, according to experts.
How common are severe allergic reactions to the COVID-19 vaccine?
The recent report issued by the CDC analyzed data from the Vaccine Adverse Event Notification System between December 14 and 23, when 1,893,360 first doses of the Pfizer-BioNTech vaccine were administered. Of these patients, 21 developed anaphylaxis. The report also found that 71% of these reactions happened within 15 minutes after patients were vaccinated, which is during the period of time that healthcare professionals recommend that you wait in your office to see if a reaction develops. However, the length of time that people experienced this severe allergic reaction varied between two minutes after vaccination and 150 minutes after.
Of the 21 people who developed anaphylaxis after being vaccinated, 17 had a history of allergy or allergic reactions and seven had a history of anaphylaxis. The CDC was able to find follow-up information for 20 of the patients who suffered anaphylaxis and found that they had all recovered or been discharged home.
There were other less serious allergic reactions as well. The CDC researchers found that 86 people had what they classified as “non-anaphylactic allergic reactions”, which can range from hives to minor swelling. To be on the safe side, the agency recommends that healthcare professionals have epinephrine (epinephrine in the form of EpiPen) and equipment available to open a person’s airway in case of a severe allergic reaction.
Overall, the report’s results are promising, says Richard Watkins, MD, an infectious disease physician and professor of medicine at Northeast Ohio Medical University. They show that “the vaccine is safe and effective,” he says, adding, “the risks of COVID-19 far outweigh those of the vaccine.”
What causes allergy to a vaccine?
Usually, a person is allergic to a specific component of a vaccine, not everything. “It is often a preservative or, in the case of the flu vaccine, it may be residual protein from the egg,” says John Sellick, DO, an infectious disease specialist and professor of medicine at the University of Buffalo / SUNY in New York.
The CDC specifically lists the following as potential causes of allergic reactions to vaccines:
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The vaccine antigen
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Residual animal protein
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Antimicrobial agents
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Preservatives
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Stabilizers
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Other components of the vaccine
Overall, however, the preservative used (thimerosal, for example) is the most common potential allergen, according to Purvi Parikh, MD, an allergist at Allergy & Asthma Network. “Normally, vaccines without preservatives are well tolerated,” she says.
Is there any way to know if you are allergic to the COVID-19 vaccine you received?
Pfizer and Moderna vaccines have not been tested in people with a history of severe allergies due to obvious concerns about the potential for potentially fatal reactions, says Stanley Weiss, MD, professor at Rutgers New Jersey Medical School and the Department of Epidemiology at the School of Public Health Rutgers.
He explains that normally “people with a previous history of allergic reactions are at an increased risk of reacting to something new”.
If you’re allergic to a specific ingredient, like glycerin, and he’s in a vaccine, you’re likely to have a reaction to it, says Sellick. The same applies to people with an egg allergy. “If you knew in advance that you had anaphylactic reactions to eggs, I wouldn’t want to give you an egg flu vaccine,” he says. (There are egg-free versions, however.)
After the Pfizer and Moderna vaccines received the FDA’s Emergency Use Authorization, the two companies released their full list of vaccine ingredients. It is not clear at this point that people have had a severe allergic reaction in any vaccine, but lipid polyethylene glycol (one of the fats used to wrap mRNA to ensure it is delivered to cells) is potentially suspect, says Alan.
Without comparing your known allergies to the ingredients of the vaccine, it can be difficult to say whether you will have an allergic reaction to a vaccine, “especially if it is the first time you have received it,” says Robert Weber, Pharm.D. , administrator of pharmacy services at Ohio State University Wexner Medical Center and assistant dean of Medical Center Affairs at Ohio State University School of Pharmacy. Unfortunately, “there is no way” to know for sure whether any person with a history of allergies will have a severe allergic reaction to the COVID-19 vaccine.
So who should and shouldn’t get the COVID-19 vaccine?
As of now, the Allergy & Asthma Network says people should “be careful” if they have a history of anaphylaxis due to another vaccine or injectable drug, and should not receive the vaccine if they have a history of anaphylaxis to any component of the COVID-19 vaccines available. People who are allergic to polyethylene glycol or polysorbate specifically should not receive any of the vaccines, according to the CDC. (Polysorbate is not found in the Pfizer and Moderna vaccines, but is closely related to polyethylene glycol.)
If you had an allergic reaction right after the first dose, you should not receive the second dose, according to the CDC. Instead, your doctor may refer you to an allergy specialist.
The CDC also recommends talking to your doctor if you have had an immediate allergic reaction to a vaccine or injectable therapy for another disease in the past, even if it was not severe, such as hives or swelling. “If someone has a concern, they should always talk to the doctor,” says Sellick. Most doctors’ offices have a policy on this, but he recommends waiting a while after being vaccinated, so they can help if you happen to have a reaction. (The CDC recommends 15 minutes if you have no history of allergies and 30 minutes if you have.)
❗If you received the COVID-19 vaccine and you think you may be having a severe allergic reaction after leaving the vaccination site, seek medical attention immediately.
If you are vaccinated in a location other than your doctor’s office, make sure that the person who is giving the vaccine is aware of your personal allergy history. As soon as the vaccine becomes more widely available, “if an allergist is concerned, he can have a skin test on you and a test with all or half of the vaccine under medical supervision in your office,” says Dr. Parikh.
Conclusion: experts emphasize that severe allergic reactions to vaccines are extremely rare and that vaccination is an important step in ending the coronavirus pandemic, so if in doubt, talk to your doctor. They will be able to guide you through the next better steps. “I have been administering vaccines for 20 years and have probably given 10,000 vaccines,” says Weber. “I didn’t see a serious reaction.”
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